We report herein our surgical experience of Hartmann's procedure reversal using laparoscopic technique in a 72-year-old woman who underwent Hartmann's procedure for an obstructing sigmoid colon cancer 6 month earlier. The purposes of this report are to describe our technique of laparoscopic reversal of Hartmann's procedure, to introduce several technical tips in avoiding pitfalls, and to review its safty and efficacy. In brief, the colostomy was freed from the abdominal wall using a conventional technique, then a center rod and an anvil of a circular stapler were inserted into the colon. CO2 insufflation was performed through this insertion. Using a five-cannula technique, rectal stump was mobilized, then colorectal anastomosis was performed laparoscopically via a transanal stapled approach. The operating time was 130 minutes and blood loss was 50 ml. There were no intra- and postoperative complications. Up to now, with a 4-month follow-up period, the patient has been well without having any problems associated with this operation
Abdominal Wall ; Aged ; Colon ; Colostomy ; Female ; Follow-Up Studies ; Humans ; Insufflation ; Laparoscopy ; Postoperative Complications ; Sigmoid Neoplasms

BACKGROUND: Recent studies have documented increased release of endothelin(ET) during acute attack of asthma. The purpose of this study is to observe the link between plasma level and urinary excretion of each and changes during acute exacerbation. METHOD: Plasma and 24 hour urine were collected from sixteen asthmatics during acute exacerbation, twice ; first day of symptomatic exacerbation and two weeks after treatment. Controls were ten healthy normal subjects. All patients were treated with corticosteroid and beta-2 adrenergic agonist on admission. ET was determined by radioimmmunoassay and had 100% cross reactivity with ET-1, 67% with ET-2, 84% with ET-3, and 8% with Big-ET. RESULTS: Plasma ETs were significantly elevated during acute attack of asthma compared with those in remission and controls. However, there was no significant changes in urine ET concentrations or total ET amounts in 24 hour urine during exacerbation upto two weeks. Those levels of urine ET in asthmatics were still higher than controls. ET concentrations in plasma or urine were not correlated with pulmonary functional parameters and hypoxemia. CONCLUSION: The findings suggests that increased plasma ETs are related with exaggerated release during acute asthma. Urinary ET excretion is increased in asthma. However, urine ET changes during exacerbation should be observed in a larger and longer scale.
Adrenergic Agonists ; Anoxia ; Asthma* ; Endothelin-2 ; Endothelins* ; Humans ; Plasma*

A nationwide survey was performed to know the distribution and prevalence of human Gymnophalloides seoi infection on western and southern coastal islands in the Republic of Korea. A total of 4,178 fecal specimens were collected from residents on 45 (24 western and 21 southern) islands, and examined by Kato-Katz and formalin-ether sedimentation techniques. Eggs of G. seoi were detected from 160 (3.8%) people living on 22 (13 western and 9 southern) islands. The prevalence varied by the location of islands; higher on western islands than on southern islands. The highest prevalence was found on Amtaedo (25.3%), followed by Cheungdo (25.0%), and Anchwado (20.9%) (Shinan-gun). A little lower prevalence was observed on Munyodo (13.3%), Shinshido (12.9%), and Sonyudo (10.3%) (Kunsan-shi). Of the remaining islands, the regions showing the prevalence greater than 5% included Kohado, Dallido (Mokpo-shi), Pyeongildo, Kogumdo (Wando-gun), and Keogumdo (Kohung-gun). A strong age predilection was noted (P < 0.05); 95% of the infected people were over 40 years old. Females showed a little higher prevalence than males. The results indicate that human G. seoi infection is more widely distributed than previously considered. Nine of 11 islands (excluding the 2 known areas Munyodo and Sunyudo) that showed greater prevalence than 5% are regarded as new endemic foci of G. seoi.
Adolescent ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Animals ; Child ; Child, Preschool ; Female ; Human ; Infant ; Intestinal Diseases, Parasitic/*epidemiology ; Korea/epidemiology ; Male ; Middle Aged ; Prevalence ; Sex Factors ; Support, Non-U.S. Gov't ; Trematode Infections/*epidemiology

The spontaneous hematomyelia is an uncommon event and its predisposing conditions are vascular malformation, syringomyelia, pregnancy and delivery, angioma, hemophilia, anticoagulant therapy, etc. We have recently experienced the patient with spontaneous onset and resolving hematomyelia in the cervical spinal cord. A 30-year-old male patient with non-traumatic spinal shock was evaluated. On MRI, a hematomyelia along cervical spi-nal cord was revealed. A suspicious AV malformation was noticed at C3-4 level. Fol-low-up MRIs showed spontaneous resolution of the hematoma.
Adult ; Hemangioma ; Hematoma ; Hemophilia A ; Humans ; Magnetic Resonance Imaging ; Male ; Pregnancy ; Shock ; Spinal Cord ; Spinal Cord Vascular Diseases* ; Syringomyelia ; Vascular Malformations

No abstract available.
Humans ; Liver Diseases* ; Liver*

To manage chronic constipation, dietary and lifestyle modifications should be tried before pharmacological intervention. Although there is no standardized treatment guideline for medical practice, the key considerations in the choice of laxative include the treatment duration, dosing schedule, type of agent, effects and side effects of the agent, and cost. The first-line treatment is a bulking or osmotic laxative. If the patient is still symptomatic, the physician can add or switch to other laxatives. Next, prucalopride, a highly selective 5-hydroxytryptamine 4 (5-HT4) receptor agonist, could be considered. If the constipation is refractory to combination therapy with conventional laxatives and prucalopride, patients should be referred for further evaluation, including physiological testing.
Appointments and Schedules ; Constipation ; Humans ; Laxatives* ; Life Style ; Serotonin

The treatment for constipation should be individualized and dependent on the cause, coexisting morbidities, and patient's cognitive status. Although most cases of constipation respond to conservative treatment, including dietary and life-style changes, or mild laxatives, some patients still complain of consistent symptoms and need an assessment of defecatory dysfunction. There is insufficient evidence to support the use of enemas in chronic constipation, although many clinicians and patients find them useful and effective for the treatment of fecal impaction when used with other modalities. In addition, suppositories can be considered as an initial trial for the treatment of defecatory dysfunction, since they help to initiate or facilitate rectal evacuation. The routine use of enemas is typically discouraged, especially sodium phosphate enemas, although tap-water enemas seem safe for more regular use. Soapsuds enemas are not recommended due to possible rectal mucosal damage.
Constipation* ; Enema* ; Fecal Impaction ; Humans ; Laxatives ; Sodium ; Suppositories*

Based on published guidelines on the management of chronic constipation, secondary causes should be excluded and then patients should be told to increase their dietary fiber intake to 20-25 g per day. If these measures do not improve the symptoms, conventional laxatives are generally the next choice. Although there is limited evidence for the efficacy of these older laxatives due to a lack of well-designed clinical trials, most clinicians agree that they are effective at relieving the symptoms of constipation. Conventional laxatives include bulk-forming, osmotic, and stimulant laxatives. Bulking laxatives consist of fiber such as psyllium, cellulose, and bran. Osmotic laxatives are classified into sugar-based laxatives and polyethylene glycol. Bisacodyl and sodium picosulfate are stimulant laxatives. Understanding their mechanisms of action, efficacy, and side effects might improve the quality of life of patients suffering from chronic constipation.
Bisacodyl ; Cellulose ; Constipation ; Dietary Fiber ; Humans ; Laxatives* ; Polyethylene Glycols ; Psyllium ; Quality of Life ; Sodium

OBJECTIVES: This study examined psychiatric characteristics including addictive behavior and personality traits among workers with hazardous drinking. METHODS: The cross-sectional study included 486 workers. Socio-demographic and clinical variables were collected, and employed the Alcohol Use Disorders Identification Test-Korean version (AUDIT-K), Korean translation of the Internet Addiction Test, Smartphone Addiction Scale, Hospital Anxiety and Depression Scale (HADS), Perceived Stress Scale (PSS), Korean version of Connor-Davidson Resilience Scale (K-CD-RISC), Big Five Inventory-Korean version-10 (BFI-K-10). Hazardous drinking was identified with the AUDIT-K score of 10 in men and 6 in women. Univariate and logistic regression analysis were used to identify factors associated with hazardous drinking. RESULTS: One hundred sixty-eight (34.6%) workers reported hazardous drinking. It was more common in men and workers with lower levels of education, workers that smoked and experienced smartphone addiction, and had experienced attempted suicide. Among the assessment scales, scores on the HADS and PSS were higher, and scores on the K-CD-RISC were lower for these workers. Regarding scores for the BFI-K-10, higher extraversion, lower agreeableness, and lower openness were related to hazardous drinking. Logistic regression analysis revealed that smoking, smartphone addiction, history of attemptd suicide, and higher scores on extraversion of the BFI-K-10 were significantly associated with hazardous drinking. CONCLUSION: Our findings demonstrate that hazardous drinking tends to coexist with other addictive behaviors such as smoking and smartphone addiction. Clinicians should also be aware of suicidal risk in people with hazardous drinking.
Alcohol Drinking* ; Anxiety ; Behavior, Addictive* ; Cross-Sectional Studies ; Depression ; Drinking ; Education ; Extraversion (Psychology) ; Female ; Humans ; Internet ; Logistic Models ; Male ; Smartphone ; Smoke ; Smoking ; Suicide ; Suicide, Attempted ; Weights and Measures

Background: This study aimed to explore the time interval distribution pattern between the Physicians Order for Life-Sustaining Treatment (POLST) form completion and death at a tertiary hospital in South Korea. It also examined the association between various independent parameters and POLST form completion timing. Methods: A total of 150 critically ill patients admitted to Korea University Guro Hospital between June 1, 2018 and December 31, 2018 who completed the POLST form were retrospectively analyzed and included in this study. Data were analyzed with descriptive statistics, and group comparisons were performed using the chi-square test for categorical variables. Fisher’s exact test was also used to compare cancer versus non-cancer groups. Results: More than half the decedents (54.7%) completed their POLST within 15 days of death and 73.4% within 30 days. The non-cancer group had the highest percentage of patients (77.8%) who died within 15 days of POLST form completion while the colorectal (39.1%) and other cancer (37.5%) groups had the lowest (P=0.336). Conclusion Our findings demonstrated a current need for more explicit guidance to assist physicians with initiating more timely, proactive end-of-life discussions.